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Medical Forum / Diseases and Disorders / Breast Cancer / October 2004

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Swollen arm

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Patrick - 31 Oct 2004 04:58 GMT
Seven years ago, my wife had breast cancer with subsequent removal
surgery and chemotherapy.

All check-ups were absolutely fine until January of this year when the
check-up revealed some suspicious-looking lymph nodes. So chemotherapy
again, and suspicious-looking nodes disappeared. However, her left arm
(the side the breast was removed) became very swollen. She has been
told that this is because the agent used in the chemo (Taxol) has
blocked ganglions thus provoking an accumulation of water in the arm.

She has been through many sessions of 'lymphatic drainage' (is that
the right term?) but all to no effect.

Can anyone suggest a way of eliminating the accumulated water and
restoring her arm to its normal size?

Any suggestions gratefully appreciated as her doctor seems short of
solutions right now.
Sandy L - 31 Oct 2004 11:15 GMT
> Seven years ago, my wife had breast cancer with subsequent removal
> surgery and chemotherapy.
[quoted text clipped - 14 lines]
> Any suggestions gratefully appreciated as her doctor seems short of
> solutions right now.

Fluid circulation in the arm enters via arteries but leaves via two
different pathways.  The blood from the arterial side goes through
capillaries, where a portion of the water and dissolved material leaks out
into the space between cells, becoming lymph.  Most of the blood goes back
to the heart via veins, but the fluid that leaked out of the capillaries
goes back into thin-walled vessels called lymphatic channels or vessels.
The fluid filters through lymph nodes.  Damage to the nodes, from surgery or
from chemo or radiation, impairs the return through this system, and the
fluid accumulates in the arm.

It may be that the symptoms will subside very slowly as healing from this
lates round progresses.  It might not, or might improve without going away.
In the meantime, an elastic sleeve can be purchased or, better yet, made to
her exact size.  In the US, the most common brand is Jobst, but there are
other good manufacturers.  Someone needs to measure her arm and hand (an
elastic glove is usually separate from the sleeve).  Jobst does that by
means of a strip of paper with perpindicular bands spaced allong it like
teeth of a comb.  You run the strip up the arm then tape the side bands
around the arm with cellophane tape, cut through the bands with a pair of
scissors, then fold the mess up and send it off.  The sleeves are hard to
get on; you will need cornstarch or talcum powder and it might even be a
two-person job.

There are other precautions.  Blood should not be drawn from that arm nor
intravenous fluids administered on that side.  Blood pressure should be
checked on the other side.  Infections in that arm should be treated quickly
and aggressively; the lymph is an excellent growth medium for bacteria and
infection can get very serious very quickly.  When prractical, sitting with
the arm elevated will slow the accumulation of fluid and speed is drainage.
mosherm@nsnet.pns.ca - 31 Oct 2004 14:57 GMT
>It may be that the symptoms will subside very slowly as healing from this
>lates round progresses.  It might not, or might improve without going away.
[quoted text clipped - 8 lines]
>get on; you will need cornstarch or talcum powder and it might even be a
>two-person job.

My post-surgery physiotherapist measured and gave me the sleeve and
hand section. You might see if you can find one who can do that.

You also might check a large pharmacy such as one connected with a
medical clinic, if you have one.  We have one here that has a section
devoted to splints, back braces, shower chairs etc. that carries the
material and will help fit it for you.  I think you can even get a
doctor's prescription to pay for it if you have insurance.  The
material is called Tubeygrip, I think.  

Marilyn
 
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